ince the first reports of cleft lip repair, surgeons have continued to innovate to maximize functional and aesthetic results. During a large portion of this time, there was a fear that correcting the cleft nasal deformity would disturb nasal or maxillary development. In the 1950s, Gelbke 1 challenged this idea by performing a primary rhinoplasty during cleft repair. His invasive approach ultimately led to poor results, which propagated concerns about early nasal interventions. Embryologic research by Latham 2 in 1970 led to further apprehension regarding primary rhinoplasty through the "septal concept of facial growth." His experiments demonstrated that the nasal septum, by means of the septopremaxillary ligament, transmits a force that induces growth of the maxilla.In the 1970s, physicians began to revisit primary rhinoplasty (PR) during cleft lip repair.McComb postulated that the procedure could Background: Primary rhinoplasty during correction of unilateral cleft lip continues to be a topic of debate because of concerns that early nasal intervention may affect nasal and maxillary development over the long term. This study aims to determine the volume and quality of evidence for and against primary unilateral cleft rhinoplasty. Methods: A systematic review was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were pulled from PubMed and EMBASE and screened by title and abstract. Studies with human participants undergoing rhinoplasty at the time of unilateral cleft lip repair and some evaluation of the nasal outcome were included. Studies with a large proportion of syndromic patients, case reports, editorials, letters, reviews, studies exclusive to bilateral clefts, and studies not available in English were excluded. Those that met criteria were then systematically reviewed. Results: Twenty-five articles were included. Ten articles that assessed the results of primary rhinoplasty subjectively all supported cleft lip repair with primary rhinoplasty. Sixteen articles assessed the results of primary rhinoplasty objectively, with 15 supporting primary rhinoplasty during cleft lip repair. Eight of nine studies that evaluated nasal growth and development over time found no restriction in nasal development. Five studies with a follow-up period of at least 6 years found that the percentage of patients who avoided revision rhinoplasty ranged from 43% to 100%. There were significant risks of bias in the majority of studies. Conclusion:The majority of studies reviewed support that primary rhinoplasty during unilateral cleft lip repair results in good outcomes with limited or no effect on nasal growth.

Along with the decrease in sudden infant death syndrome due to the successful “Back to Sleep” Campaign, there was a reciprocal increase in cases of positional plagiocephaly (PP). The prevalence of PP significantly rose from approximately 5% to upward of 46% at age 7 months. Consequently, clinicians have seen a surge in the number of patients presenting with head shape abnormalities. Not only does this increase in patient volume pose a logistical problem to clinics, but it also poses a potential risk to patients with craniosynostosis, whose head shape anomalies are similar to a “needle in a haystack” of patients with more common PP. This review explores the causes, risk factors, and treatment options of PP and craniosynostosis, along with the differential of head shape anomalies based on phenotypic presentation. In doing so, we hope to provide pediatric care clinicians with the tools necessary to effectively evaluate and manage patients with head shape abnormalities. [ Pediatr Ann . 2023;52(1):e10–e17.]